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1. Understanding the Opportunity Cost, Seizing the Opportunity: Report of the Working Group on Incorporating Economics and Modelling in Global Health Goals and Guidelines

Author:
The Working Group on Incorporating Economics and Modeling in Global Health Goals and Guidelines
Publication Date:
05-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
Internationally set goals and guidelines directly influ­ence the setting of health care priorities at the national level, affecting how limited resources are generated and allocated across health care needs. The influence of global priority setting, such as through the formu­lation of overarching goals or normative guidelines for specific disease areas, is particularly significant in low- and middle-income countries that rely heavily on overseas development assistance. Because no sys­tematic approach exists for dealing with resource con­straints, however, which vary across countries, goals and guidance are often inappropriate for some country contexts; their implementation can, therefore, reduce the efficiency and equity of health care spending. The Working Group on Incorporating Economics and Modelling in Global Health Goals and Guidelines, co-convened by the Center for Global Development, Thanzi la Onse, and the HIV Modelling Consortium, has brought together disease specialists, policymakers, economists, and modelers from national governments, international organizations, and academic institutions across the globe to address these issues, to take stock of current approaches, and make recommendations for better practice. The Working Group deliberated on the roles and purposes of goals and guidelines and consid­ered how economic evidence might be formally incor­porated into policy recommendations and health care decision making. The target audiences for this report are international health institutions, large stakehold­ers in disease programs across the world, and national governments.
Topic:
Development, Health, Health Care Policy, and Public Health
Political Geography:
Global Focus

2. Imagining the Alternative Worlds of 2030: Policy Implications for the Future of Global Health Procurement

Author:
Janeen Madam Keller and William Savedoff
Publication Date:
06-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
The availability and affordability of health products—medicines, diagnostics, devices, and equipment—are critical to achieving universal health coverage and improving health outcomes. Yet low- and middle-income countries face multiple challenges in procuring health products related to institutional inefficiencies, market failure, and fragmented demand. At the same time, the world is evolving rapidly in ways that will affect health procurement, from changes in countries’ eligibility for foreign assistance to advances in information technologies. Looking forward, efforts to improve global health procurement must proactively address the sweeping changes on the horizon. Drawing on a range of political, economic, and social trends, this paper envisions how the global landscape might change between now and 2030, with a focus on the implications for global health, particularly the procurement of health products. The paper develops three possible but distinct futures—worlds characterized as atomistic, privately led, or multilateral.It concludes by describing the policy options and locus of action to improve global health procurement in light of these scenarios, emphasizing three areas of work: financing and modes of collaboration, procurement procedures and tools, and procurement capacity.
Topic:
Health, Health Care Policy, Public Health, and Health Crisis
Political Geography:
Global Focus

3. Tackling the Triple Transition in Global Health Procurement

Author:
Rachel Silverman, Amanda Glassman, Kalipso Chalkidou, and Janeen Madan Keller
Publication Date:
06-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
There have been impressive gains in global health over the past 20 years, with millions of lives saved through expanded access to essential medicines and other health products. Major international initiatives backed by billions of dollars in development assistance have brought new drugs, diagnostics, and other innovations to the fight against HIV, malaria, tuberculosis, and other scourges. But behind these successes is an unacceptable reality: in many low- and middle-income countries, lifesaving health products are either unavailable or beyond the reach of the people who need them most. While each country’s context is unique, a reliable, affordable, and high-quality supply of health products is a vital necessity for any health system. In its absence, lasting health gains will remain elusive.
Topic:
Health, Public Health, Pandemic, Procurement, and Medicine
Political Geography:
Global Focus

4. Vaccine Introduction and Coverage in Gavi-Supported Countries 2015-2018: Implications for Gavi 5.0

Author:
Roxanne Oroxom and Amanda Glassman
Publication Date:
06-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
With a vision of “creating equal access to new and underused vaccines,” Gavi set several coverage-specific targets for 2020 as part of its Phase IV strategy, including the immunization of an additional 300 million children, increased pentavalent 3 and measles-containing vaccine (MCV) 1 coverage, and greater equity in coverage across wealth quintiles.[1] The strategy also called for broadening protection through improved routine coverage and the introduction of new vaccines.[2]
Topic:
Health, Children, Public Health, and Vaccine
Political Geography:
Global Focus

5. Global Immunization and Gavi: Five Priorities for the Next Five Years

Author:
Amanda Glassman, Cordelia Kenney, and Janeen Madan Keller
Publication Date:
06-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
Child vaccination remains among the most cost-effective uses of public and aid monies.[1] In a highly contested funding environment where priorities must be set for the allocation of scarce concessional resources, investment in expanding the availability and coverage of cost-effective vaccination must come at the top of the list. Gavi’s mission—saving children’s lives and protecting people’s health by increasing equitable use of vaccines—remains highly relevant. Gavi and its partners have made enormous progress towards increasing equity in the introduction of vaccines; children living in the lowest-income countries now have access to the same set of vaccines as those living in high-income countries. Gavi and partners have also contributed to increased coverage; immunization rates are higher in Burundi and Rwanda, for example, than in many places in the United States and Europe. Yet the effects of under-immunization anywhere can have global implications everywhere, as recent outbreaks illustrate. New or dormant threats are also a new reality—newly vaccine-preventable diseases like Ebola or virulent flu strains can spread swiftly and lethally in an interconnected world.
Topic:
Health, Public Health, Vaccine, and Immunization
Political Geography:
Global Focus

6. Tackling the Triple Transition in Global Health Procurement

Author:
Rachel Silverman, Janeen Madan Keller, Amanda Glassman, and Kalipso Chalkidou
Publication Date:
07-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
There have been impressive gains in global health over the past 20 years, with millions of lives saved through expanded access to essential medicines and other health products. Major international initiatives backed by billions of dollars in development assistance have brought new drugs, diagnostics, and other innovations to the fight against HIV, malaria, tuberculosis, and other scourges. But behind these successes is an unacceptable reality: in many low- and middle-income countries, lifesaving health products are either unavailable or beyond the reach of the people who need them most. While each country’s context is unique, a reliable, affordable, and high-quality supply of health products is a vital necessity for any health system. In its absence, lasting health gains will remain elusive. Access to medicines, diagnostics, devices, and equipment is driven in large part by the efficiency of their procurement. Procurement is, therefore, central to the efforts of low- and middle-income countries to improve health, meet the Sustainable Development Goals, and achieve universal health coverage. Health product purchasing in low- and lower-middle-income countries already makes up a sizeable share of overall health spending; in fact, in just a subset of these countries, spending on health products totals an estimated $50 billion per year.[1] Procurement is not only essential to the missions of global health entities like the Global Fund, Gavi, UNICEF, UNFPA, and PEPFAR, but it also represents big money. In the case of the Global Fund, health product procurement accounts for $2 billion per year,[2] or almost half of its 2017 disbursements.[3] Yet despite its importance, procurement is an underappreciated health system function. Today’s procurement systems are hobbled by inefficiencies that leave some of the poorest countries paying some of the highest drug prices in the world.
Topic:
Health, Public Health, Transition, and Procurement
Political Geography:
Global Focus

7. Why Uncertainty in Global Health Interventions Matters—and What We Can Do About It

Author:
Kalipso Chalkidou, Anupama Dathan, and Francis Ruiz
Publication Date:
09-2019
Content Type:
Policy Brief
Institution:
Center for Global Development
Abstract:
Global health interventions, like many public policies, are rife with uncertainty. Will a program, such as a malaria prevention strategy that looks strong on paper, work as intended? Will a new technology, such as a specific drug or device that appears effective in clinical trial settings, work in practice and provide good value-for-money? In the case of programs made up of a complex interaction of multiple interventions, implementers often create a theory of change and then meticulously track whether it is being followed every step of the way, from each input translating into the prespecified activity, and the activities yielding the right outputs and the expected outcomes. When observational data is available that permits quantitative analysis (evaluation), it may also be possible to estimate causal impact in a given setting by applying experimental methods (such as a randomized controlled trial) or quasi-experimental techniques (such as difference-in-difference analysis). Such program evaluations generally consider outputs (e.g. the number of bed nets distributed) and relatively short-term outcomes (e.g. malaria infections following bed net distribution). Many eval- uations also collect data years after the program to identify longer-term impacts. Cost-effectiveness calculations are sometimes conducted after ascertaining the cost and impact of the program, but such analyses aren’t necessarily considered when determining whether to implement a certain program or technology—especially when politics and other concerns get in the way. Discrete clinical interventions and technologies (which are defined as including clinical interven- tions, drugs, diagnostics and even public health programs) are usually the subject of health technolo- gy assessment (HTA) to inform coverage decisions in many contexts. The underpinning evidence base for HTA typically involves a synthesis of randomized trial data, designed to reduce bias in estimating causal inference and relative effectiveness. Trial data is then combined with information from other sources and study designs to develop models of the technology’s long-term health and cost impact in a given context. A key feature of both programs and technologies is uncertainty.
Topic:
Health, International Cooperation, Science and Technology, Humanitarian Intervention, and Pharmaceuticals
Political Geography:
Global Focus